A Case of Severe Malaria With Disseminated Intravascular Coagulation in an American Missionary and Review of Current Treatment and Prophylaxis

Abstract

Malaria remains a significant global health concern, particularly in endemic regions. Despite the availability of preventive measures, cases continue to emerge in the United States of America (USA), especially among travelers such as missionaries, military personnel, and aid workers to endemic areas. Factors contributing to morbidity and mortality include suboptimal prophylactic protocols, delayed diagnosis and treatment, and the limited availability of life-saving antimalarial medications like artesunate. This case report examines the clinical course and challenges faced by a 47-year-old male American missionary who developed severe malaria after returning from Nigeria. Initially, the patient was misdiagnosed with sepsis due to his nonspecific symptoms, which included fever, weakness and hematuria. However, a peripheral blood smear later confirmed he was infected with malaria. Despite receiving oral antimalarial therapy, the patient’s condition worsened, leading to disseminated intravascular coagulation (DIC) and severe malaria. Artesunate, the recommended treatment for severe malaria, was not immediately available at our hospital, prompting the urgent transportation of the medication from a tertiary care center. After receiving artesunate, the patient’s condition improved, and he was discharged to outpatient care 6 days later. This case study highlights the significant challenges related to nonadherence to malaria chemoprophylaxis protocols, and the shortage of artesunate in US hospitals, and suggests potential frameworks to improve prophylactic guidelines and clinical outcomes.